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Data Suggest That There Could Be Room for Coordination and Improvement in Rationalization of Care Across the Veterans Health Administration (VHA) and the Rest of the U.S. Health Care System

• The authors find evidence of use of the VHA or non-VHA systems for reasons of convenience. 45–64-year-old veterans using only VHA hospitals for inpatient care lived closer to VHA hospitals (by a distance of about one-third) than veterans using only non-VHA hospitals. Also, veterans with sources of coverage other than the VHA were more likely to use non-VHA facilities.
• Studies of hospitalization rates suggest that there may be inefficiency in care provided in VHA hospitals. Lengths of stays in VHA hospitals were 63-percent longer for younger veterans and 27-percent longer for older veterans (> age 65), though veterans admitted to VHA hospitals were younger and had fewer comorbidities on average.
• Many VHA hospitals have low volumes of many high-risk procedures, which could explain higher mortality rates and could also result in high unit costs if economies of scale are present.
• A recently published study found substantial duplication of services provided to veterans who obtain care from both the VHA and the private sector via the Medicare Advantage program. The VHA provided services potentially valued at over $13 billion for care between 2004 and 2009 for VHA users who were concurrently enrolled in Medicare Advantage plans — that is, plans that had already been paid by Medicare to provide essentially that same care to these enrollees.